Introduction by Croakey: Wide-ranging efforts are needed to improve the safety and quality of healthcare for First Nations people in prisons, including through innovation, investment, and accountability, experts told a timely webinar hosted by Croakey this week.
Marie McInerney reports below – and also see her live-reporting on X/Twitter.
Marie McInerney writes:
Funding Aboriginal and Torres Strait Islander health services to play a much bigger role in prison healthcare, and the provision of healing programs are critical for First Nations people in prisons, who too often receive sub-standard, poorly coordinated and culturally unsafe healthcare from mainstream services, a CroakeyLIVE webinar was told this week.
Indigenous prison health experts also highlighted the need to challenge and rewrite harmful public and policy narratives that contribute to shocking levels of overincarceration for Aboriginal and Torres Strait Islander people and the need to transform services that inflict harm and punishment rather than delivering therapeutic care to those who have experienced racism, violence and trauma.
“A lot of these men and women, they were victims before they were perpetrators,” said Julie Tongs OAM, a Wiradjuri woman and CEO of the Canberra-based Winnunga Nimmityjah Aboriginal Health and Community Services, one of the few Aboriginal Community Controlled Health Services (ACCHS) contracted to work directly in prisons.
“What we’re dealing with is poverty, trauma and addiction,” she told the webinar.
That’s particularly so for young Aboriginal and Torres Strait Islander children and young people in juvenile detention, who have “just had really hard lives”, she said.
“They just keep getting punished and it’s got to stop.”
Fellow panellist Dr Mark Wenitong, a Kabi Kabi man and long-term prison healthcare provider, agreed, saying that while some people need to stay in prison for the long-term, the majority of Aboriginal and Torres Strait Islander people in prison are “not hardened criminals”.
Rather, they are people who “stuff up” or suffer from poor treatment in a justice system where some police still think they are “policing the colonies to protect them from the black fellas”.
Wenitong, who has contributed to coronial inquiries and other reviews of prison healthcare delivery, said overincarceration of young Aboriginal and Torres Strait Islander people is “out of control”, pointing particularly to Western Australia where the rate of detention of young Indigenous people is 58 times that for non-Indigenous young Western Australians.
“You can’t possibly have a normal healthy generation coming through if they’ve been through juvie (juvenile justice),” he told the webinar.
“How do we turn around that prison system: instead of it being just a punishment system to (being) a therapeutic system?”.
Wenitong called for real innovation in prison reform and services that address issues like family violence, which contributes so much to adverse childhood experiences that lead to chronic diseases, mental health issues and substance abuse later in life.
“We can actually see generational change if we start thinking through this now and stop talking about healing and start doing things about healing. The guys that I deal with inside…there’s anger, but there’s a lot more sadness than there is anger,” he said.
Prison reform should also put an end to the privatisation of prisons across Australia, which holds more prisoners in private prisons per capita than anywhere in the world, said panellist Jack Bulman, a Muthi-Muthi man and CEO of Indigenous health promotion charity Mibbinbah Spirit Healing.
Mibbinbah runs multiple programs in justice and health, including the ‘Be the best you Can Be’ program that draws on the Australian feature film Mad Bastards to address racism, trans-generational trauma, and loss of culture, identity and land that lie behind over-incarceration.
“I don’t think [prisons] should be places for you to make a profit on,” he said.
Preventing incarceration
The #CroakeyLIVE webinar was moderated by Croakey director and contributing editor Professor Megan Williams, who is Wiradjuri, a Principal of Yulang Indigenous Evaluation, and an adjunct of UTS, with a long-standing role in prison health research and coronial investigations.
Sponsored by Girra Maa, the UTS Faculty of Health’s Indigenous Health Discipline, the event is one of a series of Croakey webinars to mark the 40th anniversary of Medicare.
Williams dedicated the webinar to the more than 560 Aboriginal Torres Strait Islander people whose lives have been lost in correctional centres and police operations since the 1991 Royal Commission into Aboriginal Deaths in Custody, and to their families and communities who bear such pain and trauma as a result.
The ultimate purpose of the discussions, she said, was to investigate ways to not only prevent deaths in custody, but prevent incarceration.
“We are absolutely clear about [the need for] reducing numbers of people in prison, reducing risks of incarceration, and we speak about prison health services because there are so many people currently in prison with multiple and compounding health issues that often urgently require healthcare,” she said.
During the webinar, Professor Virginia Barbour, editor in chief of The Medical Journal of Australia, said she had not appreciated that prisoners were ineligible for Medicare until the MJA published this recent letter, which noted that, despite years of advocacy from a diversity of stakeholders, including the Australian Medical Association, “this remarkable inequity has persisted”.
Croakey has reported numerous calls for access by prisoners to Commonwealth-delivered Medicare services and the Pharmaceutical Benefit Scheme.
A trial is currently underway, co-led by Dr Jocelyn Jones, a Nyoongar woman with Wadjuk, Ballardong and Palyku connections, from the National Drug Research Institute at Curtin University, to fund and enable ACCHOs to provide Medicare approved and culturally safe services to Aboriginal prisoners in New South Wales, Western Australia and South Australia.
Jones told Croakey the research team had been advocating for selected Medicare items to be made available to people in prison and the trial would focus on the following MBS items:
- Health Assessment for Aboriginal and Torres Strait Islander people (MBS item 715)
- Follow-up service provided by an Aboriginal and Torres Strait Islander health practitioner (MBS item 10987)
- Multidisciplinary case conference (MBS item 735) for discharge planning
- Comprehensive health assessment (MBS item 705) post-release.
The Federal Department of Health and Aged Care has also engaged the Nous consultancy group – led by Maria Jolly, Nous Principal, and Craig Ritchie, Nous Associate and Chair of Winnunga Nimmityjah — to conduct a national review, due to report in June 2024, of healthcare in custodial settings and barriers to culturally safe healthcare for First Nations people in prison and youth detention.
The #CroakeyLIVE panel offered many solutions and made clear that, while Medicare and PBS reform are important, they are only part of the solution.
Much can and must be done to address the social determinants of health that lead to prison, to provide healing in prisons, and to prevent poor quality and unsafe mainstream care, often delivered by a workforce trained for “security and order” rather than health and wellbeing.
Latest report
The Australian Institute of Health and Welfare (AIHW) this week released its latest report on the health and wellbeing of First Nations people in Australia’s prisons. On 30 June 2022, 12,900 Aboriginal and Torres Strait Islander people were in Australia’s prisons, making up a shocking 32 percent of the prison population versus 3.8 percent of the overall Australian population.
More than two in five (43 percent) prisoners who were surveyed on entry had a history of a mental health condition, while 38 percent had a chronic physical health condition, and nearly half reported a chronic health history, including asthma, arthritis, back problem, cancer, cardiovascular disease, chronic kidney disease, diabetes, osteoporosis, and/or pulmonary disease.
Nearly three-quarters of 200 Aboriginal and Torres Strait Islander people surveyed for the AIHW report as they were leaving prison rated their prison healthcare as good or excellent.
But this was not a verdict shared by the panel, with Wenitong saying his reviews for coronial and other inquiries revealed healthcare that was sub-standard, breached duty of care and “borders on neglect”, with instances where the very basics of care – taking a pulse, blood pressure and temperature checks – were neglected.
Bulman echoed the concern, saying he had done “a hell of a lot of work in jails” since 2005, but learning about the lack of access for Aboriginal and Torres Strait islander people to healthcare in Victoria’s prisons, while working on a recent Victorian Ombudsman inquiry, “just blew me away”.
“It actually brought tears to our eyes,” he said, talking about the level of power over people’s health granted to prison staff, who lack the necessary skills and qualifications to make informed judgements. “That’s why our people are passing away in jail,” he said.
In the Victorian Ombudsman report that Bulman and Williams contributed to, and Croakey reported on, the quality of data in prison settings generally was described as poor. The panel concurred, highlighting gaps in record keeping about health care in prisons and following release that, Williams said, are profoundly evident in coronial investigations and difficult to improve given boundaries and breakdowns between corrective services, justice health, health departments and ACCHOs.
Community controlled care is critical
The #CroakeyLIVE panel also discussed the need for healing programs in prisons, including traditional healing, that could deliver intergenerational benefits, and the importance of belonging and identity.
So much of what happens in and about prisons is “out of sight, out of mind” in policy and public awareness, Bulman said. If it costs $197,000 per day to keep a person in prison, “surely that money can be better spent going to programs that help”.
Another theme was the importance of self-determination, community control and autonomy for organisations in caring for Aboriginal and Torres Strait Islander prisoners. Increasing the number of Indigenous people in the prison workforce is not enough, particularly, Williams said, given a history of not retaining Aboriginal and Torres Strait Islander staff or developing their careers over time and their frequent experiences of racism.
Wenitong said it was vital to have Aboriginal and Torres Strait Islander health organisations providing direct care in prisons, if Australia is to comply with international rights treaties that commit to “equivalence”, where all citizens, including those in prison, are entitled to the highest attainable standard of physical and mental health.
Commmunity controlled care is the “only useful standard” of healthcare for Aboriginal and Torres Strait Islander people, Wenitong said, “because nothing else has really worked for us, so anything less than a very proactive, holistic model of care is not going to be that useful”.
Aboriginal and Torres Strait Islander health services also better understand the epidemiology of disease and illness in Aboriginal and Torres Strait Islander people, where life-threatening conditions can occur much earlier than for non-Indigenous Australians.
“You need clinicians whose ears will prick up when an Aboriginal man says ‘I’ve got chest pain’ and they’re 22 [years old],” knowing to order an immediate ECG rather than assume it was only reflux given the prisoner’s age, he said.
“We know the epidemiology of disease in our populations very well. And we know their social stuff very well. And we probably know most people’s families as well,” he said.
Standing separately
Tongs said Winnunga Nimmityjah’s prison health service provides doctors, nurses, clinical psychologists, a forensic psychologist, mental health nurse, optometrists, and an Aboriginal support worker to Aboriginal and Torres Strait Islander people held in the Alexander Maconochie Centre (AMC), the ACT’s mixed prison.
Winnunga also offers a justice reinvestment program and is awaiting approval for a 24-bed cultural residential rehabilitation centre, with medicinal gardens, where residents will be able to learn about how to make traditional medicine and art and share in family gatherings.
Critically, the Winnunga AMC Health and Wellbeing Service is run as part of the overall Winnunga service, allowing integration of care between prison and community.
However, many improvements are needed, ranging from adequate funding overall to timely access to medical appointments outside the prison, improved access to outpatient specialist services at Canberra Hospital, and more focus on mental health and disability services, she earlier told Croakey.
The 2016 Moss report, titled ‘So Much Sadness in our Lives’, into the death in custody of Steven Freeman recommended that Winnunga Nimmityjah’s prison health service be integrated into the AMC.
However, Tongs was firmly against the move, wanting to retain autonomy. “I said, under no circumstances are we going to be integrated, we’re going to stand alone because I’m not prepared to share their risk,” she said.
Wenitong also warned against the tendency for health professionals in the justice system to side with the system rather than being advocates for their patients.
He highlighted structural failings, including the need for a health IT system “that follows the prisoner inside and outside” and for better connections between post-release services and systems. Many prisoners were released without notice to health or support organisations, putting follow-up healthcare at risk.
Tongs urged Aboriginal Community Controlled Health Organisations (ACCHOs) to engage with any prisons in their local areas, and emphasised the importance of healing and other programs to address violence while people are in prisons.
“At the end of the day, those men and women are going to come back into the community and we want them to come back in a better state of mind than when they went in,” she said.
Closing the discussion, Williams said that, beyond opening up access to Medicare for prisoners, there was also a need for accountability from workforces and systems.
She quoted Alexis Wright (see below) from her collective memoir of Tracker Tilmouth, saying the #CroakeyLIVE discussion had probably “named all the battles”. She called on attendees to commit to solidarity and bearing witness to what’s going on in prisons, in the context of the Closing the Gap Agreement with its priority reforms and opportunity for accountability.
“Don’t for a moment take your eyes off that in relation to prison health,” she urged.
Note: Further information was added to this article post-publication.
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